Duty of Candour Guidance Updated – NMC & GMC

The NMC and GMC have updated its duty of candour guidance. We look at the duty of candour and the updated NMC and GMC guidance.

NMC and GMC “refresh” duty of candour guidance

According to both regulators:

“The refreshed version of the guidance includes updates about reporting systems, terminology, and the support available to health and care professionals. However it hasn’t created any new or additional requirements for professionals.”

The guidance consists of two parts:

Healthcare professionals, including doctors, nurses, midwives and nursing associates, have a duty to be open and honest with the people who use services, and those close to them. This includes explaining when and why things have gone wrong, and apologising to them.
Healthcare professionals also have a duty to report incidents, and be open and honest with their colleagues, managers, and employers. This might include their health board, trust or head office, and their regulators.

What is the duty of candour?

All healthcare professionals have a duty of candour – a professional responsibility to be honest with patients when things go wrong.

A joint statement by medical regulatory bodies sets out the following practical approach to the duty of candour:

tell the patient (or, where appropriate, the patient’s advocate, carer or family) when something has gone wrong;
apologise to the patient (or, where appropriate, the patient’s advocate, carer or family);
offer an appropriate remedy or support to put matters right (if possible); and
explain fully to the patient (or, where appropriate, the patient’s advocate, carer or family) the short and long term effects of what has happened.

The duty of candour is not limited to openness and honesty with patients. There is also a duty to be open and honest with colleagues, employers, relevant organisations and regulators when taking part in reviews and investigations when requested and where appropriate.

Statutory duty of candour

The duty of candour is more than an ethical requirement. Since 2014, organisations registered with the CQC in England have a statutory duty of candour.

Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 intends to make sure that providers (both NHS. independent healthcare bodies and providers of social care) are open and transparent in relation to care and treatment with people who use their services.

It also sets out some specific requirements that providers must follow when things go wrong with care or treatment, including informing people about the incident, providing reasonable support, giving truthful information and apologising when things go wrong. The CQC can prosecute for a breach of parts 20(2)a and 20(3) of this regulation.

Candour in practice

The “Openness and honesty when things go wrong: the professional duty of candour” guidance offers specific advice on candour in practice:

Discuss risks before beginning treatment or providing care – Patients must be fully informed about their care. When discussing care options with patients, you must discuss the risks as well as the benefits of the options.
When to apologise to the patient – When you realise that something has gone wrong, and after doing what you can to put matters right, you or someone from the healthcare team must speak to the patient. The most appropriate team member will usually be the lead or accountable clinician.
When to speak to a patient or those close to them – You should speak to the patient as soon as possible after you realise something has gone wrong with their care. When you speak to them, there should be someone available to support them (for example a friend, relative or professional colleague). You do not have to wait until the outcome of an investigation to speak to the patient, but you should be clear about what has and has not yet been established.
Being open and honest with patients about near misses – A ‘near miss’ is an adverse incident that had the potential to result in harm but did not do so. Sometimes failing to be open with a patient about a near miss could damage their trust and confidence in you and the healthcare team.

Reflection, Insight & Remediation

In addition, a fitness to practise panel may view an apology as evidence of insight. The reality is that sometimes things do go wrong. When this happens, reflection is important for any healthcare professional to gain insight into the circumstances that led to things going wrong and from this to demonstrate remediation.

Insight and remediation must be genuine and demonstrable. Insight Works Training is a leading provider of remediation training delivered by leading defence tribunal barristers and clinicians, widely respected by health and social care regulators.